Nonalcoholic fatty liver disease (NAFLD) represents a spectrum of disease. Its increasing prevalence is a direct result of historically high rates of obesity. Hepatocyte lipid accumulation is the first step in a cascade of metabolic and inflammatory events thought to precipitate NAFLD. Histologic findings provide insight into these events. Lifestyle modification remains the primary therapy in children. Current recommendations include vitamin E treatment in those with biopsy-proven NASH. Trials of novel drugs are ongoing in adults. As efficacy/safety are established, these therapies may be tenable for use in children. At the current time, biopsy-driven histology endpoints are necessary to establish whether future therapies can improve pediatric or adult-type NASH in children.
Key points
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Nonalcoholic fatty liver disease (NAFLD) manifests as a spectrum of disease (steatosis to steatohepatitis to cirrhosis) and its increasing prevalence is a direct result of rapidly rising obesity rates.
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Pediatric NAFLD may be distinctly different from that found in adults by histologic evaluation; however, the cause of these differences is unknown.
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The exact pathophysiology of NAFLD is largely unknown, but histologic findings provide insight into possible mechanisms and targets for therapy.
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Few effective therapies are successful in treating NAFLD, and lifestyle modification remains the first-line of therapy in children.
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Randomized, controlled trials demonstrate resolution of NASH with vitamin E therapy, which is the current recommended treatment in pediatrics by expert guidelines.
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